Infectious Diseases

Male problem

07/08/2002

Question:

I`m male and 22 years old. About three months ago I had a burning sensation while urinating in the AM. By early evening the pain was horrible and a yellow discharge occured. I went to the emergency room and a urine test was done. The nurse told me to wipe the head of my penis and catch my urine half way through. Two cotton swabs were also taken from inside the head of my penis. I was told that I probably had clymidia.

However, the tests for clymidia and gonorrea came back negative. The doctor apologized and told me that I had a urinary tract infection. I brought the lab results to my regular doctor and he agreed.

I`m just concerned because the internet tells me that males do not get urinary tract infections. I`ve been doing research myself and now have a copy of my urine test. It shows red blood cells 100+ (HPF), white blood cells Packed (HPF), bacteria 3+ (HPF), protein 3+ and leucocytes 2+.

I also asked why the doctor at the emergency room told me I had clymidia when the urine test showed otherwise. I was not given a good answer. Can you please give me your opinion?

Answer:

I cannot comment on your specific case or symptoms, but I can provide you with some basic information about urinary tract infections in men and sexually transmitted infections.

Contrary to what you may have read, men can (and do) get urinary tract infections. However, the occurrence of urinary tract infections in men is much less common than in women. Urinary tract infections in men tend to occur later in life, but they can occur at any age. Even though one episode of a urinary tract infection in a man is unusual, it should not be concerning for underlying problems. It is only when these infections occur repeatedly that concerns for other problems need to be raised.

Symptoms of urinary tract infections can vary. Some may experience a burning pain during urination, some may experience fever. The presence of blood in the urine or cloudy and foul smelling urine can be signs of a urinary tract infection. A person with a urinary tract infection may experience pain or spasms or cramping in the bladder (felt just behind or at the level of the pubic bone); he/she may just generally not feel well either. If the urinary tract is affected all the way up to the kidneys, then there may be aching or pain in the mid-to-low back areas as well. Many of these symptoms occur at any time, and not just with urination. Discharge from the penis in men happens much less commonly during urinary tract infections.

However, discharge from the penis is a common indication that a sexually transmitted disease may be present. Discharge from the penis is a sign of urethritis; this means that an irritation has occurred to the lining of the urethra (the passage that connects the bladder to the penis and through which urine exits the body). Common causes of urethritis in young men tend to be sexually transmitted infections such as chlamydia, gonorrhea, and ureaplasma. However, there are other causes of urethritis, including rheumatologic diseases (e.g. Reiter`s syndrome), the presence of foreign bodies in the urethra (e.g. urinary catheters) or irritation from chemicals can cause some pain with urination (e.g. alcohol). Urethritis can cause painful urination.

Regarding the testing for presence of urinary tract infections and sexually transmitted infections that cause urethritis the common methods include doing a urinalysis and a urine culture for evidence of a urinary tract infection, and doing direct tests of the urethra (obtaining specimen for analysis by placing a swab in the portion of the urethra that is in the penis) for evidence of common sexually transmitted infections that cause urethritis. A urinalysis looks at the urine directly under the microscope for signs of irritation or other abnormalities. The urine culture is designed to actually grow bacteria that may be causing a urinary tract infection; it looks for the most common causes of urinary tract infections. The tests of the urethra (i.e. the swabs) typically look for the presence of certain sexually transmitted organisms; these tests may involve either the direct growing of the bacteria in culture or looking for evidence that DNA from the bacteria are present. The tests of the urethra do not necessarily look for all the causes of sexually transmitted infections; the actual organisms that can be identified vary from place-to-place depending upon the types of tests used. None of these tests is 100% accurate, but they are pretty good if they are collected under the appropriate circumstances. The culture of the urine and the tests of the urethra look for the most common causes; however, if an unusual infection is causing the symptoms, these tests may not detect it. Also, the sequencing of how the tests are collected can be important; for example, if the swab specimen of the urethra is obtained directly after a person provides a urine specimen the ability to detect a sexually transmitted infection (even when it is definitely present) by the test of the urethra may have been compromised (the act of urinating causes a stream of urine to come through the urethra and may actually cause most of the infection of the urethra to be flushed out with the urine, leaving the remaining infection at such a low level that the test is unable to detect it). Another example of the importance of sequencing can involve the urine specimen; if the specimen is obtained from the first part of the urine that comes out of the penis, then it may contain `flushed material` from the urethra that may cause the urinalysis to show signs of irritation (this is why the usual instructions for obtaining urine include having the first part of the urine to come out of the penis be discarded and then the urine to come during the middle or later part of urination to be collected--it is an attempt to try to distinguish irritation of the urethra from irritation that may be coming from further up in the urinary tract).

The Centers for Disease Control and Prevention (CDC) maintains a good website for basic information about infectious diseases. The questioner is also directed there as a source of information. It can be accessed at http://www.cdc.gov Once at the home page for the CDC click on the icon for `Health Topics from A to Z.`

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